frames counselling
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7/30/2019 FRAMES Counselling
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WHAT ARE BRIEF INTERVENTIONS?
Brief interventions, as discussed here, comprise a single
or several short (5-15 minutes) counselling sessions, that
can be delivered by any health or social services worker.
Their efficacy in reducing the harmful use of substances
is well demonstrated and workers from all disciplines
should take opportunities to deliver such interventions
in the course of their every-day work.They are aimed
at the patient who has not openly reported a drug or
alcohol problem, rather than the individual who has
actively sought help for a drug or alcohol problem.
They thus comprise two main elements: identification
of the problem via a screening-based approach, and the
counselling intervention itself.
HOW DO I DELIVER A
BRIEF INTERVENTION?
There are two stages:
STAGE ONE:
IDENTIFICATION OF A PROBLEM
Problem substance users can be identified by use of
the CAGE questionnaire (Section A2).This has a
high sensitivity (pick-up rate); if there are two ormore positive responses to the four questions, then it
is advisable to proceed to the counselling intervention.
STAGE TWO:
5-10 MINUTES DISCUSSION
using counselling skills
The FRAMES approach utilises best practice for the
delivery of substance misuse-related brief counselling
interventions. Confrontational styles tend to be ineffec-
tive (Miller W et al, 1993). Rather, the themes of
effective counselling are to Roll with Resistance, toavoid confrontation, and to lead the patient towards
making their own decisions.
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BRIEF INTERVENTIONS
BRIEF
IN
TERVENTIONS
A3
FEEDBACK
So,you say your difficulty getting to work
on time may be related to alcohol.
RESPONSIBILITY
Well, only you can make the decision to
stop drinking for the next two weeks.
ADVICE
Yes, I recommend you stop drinking for two
weeks, to see if that makes a difference.
MENU OF OPTIONS
If this turns out to be too hard, we can
consider other options such as AA or
referral to the specialist team.
EMPATHY
I know this will be hard for you because
you feel alcohol helps you relax, and Im
concerned about the amount of stress
you have.
SELF-EFFICACY
Considering how difficult you find this,
Im impressed by your willingness to
consider a change.
FRAMES COUNSELLING
APPROACH
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BRIEF
IN
TERVENTIONS
DO BRIEF INTERVENTIONS WORK?
There can be little doubt that such interventions are
effective; over the last decade a wealth of evidence has
accumulated in favour of their effectiveness. Most of the
studies are on populations of drinkers (greater public
health implications), but there is no reason to believesimilar interventions should not be effective for non-
dependent illicit substance misusers and smokers
(Russell M et al, 1979).Brief Interventions typically
yield around a 25% reduction in alcohol consumption
compared with control conditions. One meta-analysis
of six fairly compatible studies reported a 95% confi-
dence interval of 18-31% (Effective Health Care Team).
On average, three patients will need to receive such an
intervention for one of the three to benefit (Wilk A
et al, 1997).The reductions in alcohol use seem to be
maintained at 12 months (Fleming M et al, 1997), and
have been demonstrated to be effective in elderly aswell as younger populations (Fleming M et al, 1999).
There is some indication that men may benefit more
than women (Kahan M et al, 1995).An international
multicentre randomised controlled trial conducted by
The WHO Brief Intervention Study Group studied
1260 men and 299 women who were drinking at levels
considered to put them at risk of alcohol-related
problems, but who had no prior history of alcohol
dependence.They concluded that brief interventions
were consistently robust across healthcare settings and
socio-cultural groups (WHO Brief Intervention Study
Group, 1996).
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A3
FIRST APPOINTMENT:
Identify alcohol problem with the
CAGE questionnaire.
Use FRAMES counselling approach.
Take blood for GGT.
Book second appointment for one
months time.
SECOND APPOINTMENT:
Discuss the most common reasons for an
elevated GGT, including alcohol, within
the FRAMES approach.
Ask the patient to consider the reasons for
their raised GGT.
Take a second GGT, and mail the result
to the patient.
Plan to review in one year.
For drinkers, a combination of this approach
with feedback on GGT levels has been shown
to be effective (Nilssen O, 1991):
Further components may be built in such as making a
list of drinking/drug using cues, keeping a drinking/
drug use diary, signing a drinking/drug using
agreement, dispensing written self-help materials.
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